Not without Family Planning: Why Reproductive Health Security Must Be at the Center of Universal Health Coverage

This week, conference organizers announced[7] that the anticipated 2015 International Conference on Family Planning (ICFP) in Nusa Dua, Indonesia would be postponed due to a volcanic ash cloud limiting air travel and presenting health concerns. We stand in solidarity with all those in the region. Although the conference is postponed, the family planning conversation must go on.

Earlier this fall, the 193 member states at the 70th United Nations General Assembly ratified and launched the Sustainable Development Goals (SDG). Now, stakeholders are determining together how to achieve the 17 goals and 169 targets. Management Sciences for Health (MSH) works primarily toward Goal 3: to ensure healthy lives and promote well-being for all at all ages and related targets by 2030.

UHC is defined by an aspirational vision that everyone receives all the services she needs without financial hardship—but, realistically; low-income countries must start with modest services. ... UHC efforts start with changing how healthcare is paid for: instead of patients paying out-of-pocket for care whenever they need it, more money goes into the system upfront so that services can be inexpensive or free at the point of use. ... Many developing countries working towards UHC have funded the system by passing new taxes, boosting government commitment behind healthcare for the less-advantaged.

With a lot more money in the system upfront, governments can plan services better, investing in more equitable and sustainable models.

To achieve targets for UHC and reducing maternal mortality, countries must prioritize family planning and reproductive health. These cost-effective interventions save lives by: reducing maternal mortality, preventing child deaths, and contributing to an AIDS-free generation. Meeting the unmet need for family planning could reduce the number of maternal deaths by one-third.

As nations move forward in pursuit of UHC, they must include family planning and reproductive health services and supplies among entry points.

UHC and ensuring contraceptive security

UHC and reproductive health commodity security are closely intertwined. UHC is rights-based and furthers the principles of equity, access, and quality. Reproductive health commodity security includes these same three principles and one more: choice[11]. Reliable provision of health services and commodities depends on the availability of high-quality, affordable essential medicines and associated supplies.

We recommend countries working toward UHC, remember these three lessons:

Family planning is cost-effective and plays a critical role in the realization of UHC. Family planning is cost-effective for saving lives and avoiding more expensive health services, like emergency obstetric care. Yet, when confronted with finite resources and competing priorities, some countries have failed to include RH supplies, particularly contraceptives, in health packages. This occurred during past health reforms and implementation of Sector-wide Approaches[12] (SWAp), decentralization of health programs and integration of health services. As one of us blogged[10]:

Family planning is an ideal candidate for even the most frugal plans: it’s low-cost and dramatically high-impact. Plus, family planning supports the sustainability of UHC, as a proven driver of economic growth. A core package of services for reproductive, maternal and child, driven by community health workers, provides the logical cornerstone of UHC plans in developing countries.

All stakeholders working on RH have important roles to play in advocating, planning for, implementing, and monitoring the availability of RH supplies in the context of UHC. This includes donors, policymakers, advocates, as well as service providers and supply chain managers in the public, private, and nongovernmental organization (NGO) sectors. In particular, country governments must serve as stewards of the reforms and in ensuring the availability of high-quality RH supplies. Their roles are decisive in guiding, shaping, and overseeing the policy direction and required financial, operational, and regulatory systems. They are responsible for leveraging and coordinating the diverse stakeholders to ensure RH supplies are well positioned in the reforms and will be available to those who need them.

To realize UHC, stakeholders must ensure that:

RH services and supplies are part of the benefit health plans included in UHC mechanisms such as national health insurance.

Monitoring and accountability strategies are an integral part of UHC implementation.

UHC presents the RH community with the opportunity to make the case for a total market approach for RH supplies. In virtually any low- or middle-income country, the successful realization of UHC will require multiple service-delivery channels and supply chains to reach all segments of the population. As countries embark on UHC, their governments will need to make difficult decisions, such as which RH services and commodities will be provided and which population segments will be prioritized for coverage within the public sector. Governments will also need to develop, support, and enable service-delivery solutions in collaboration with the private and NGO sectors to ensure that the RH needs of the entire country’s population are met.

The UHC reform process likely will be challenging for governments and civil society to navigate—and for RH supplies stakeholders to identify entry points. But, given the role that UHC will play in the new SDGs and the number of countries now embarking on this process, we must seize the opportunities UHC holds for strengthening RH commodity security, while we also proactively mitigate any potential risks it poses. Just as there is no one single best path to UHC, there is no silver bullet or single solution to ensure availability and access to RH supplies. We will need to be opportunistic and flexible in adapting to each country’s trajectory.

Beth Yeager and Fabio Castaño serve on the newly-formed UHC Steering Team of Reproductive Health Supplies Coalition (RHSC). Portions of this post originally appeared on the RHSC Blog[13]. Find out more about UHC and reproductive health supplies here[14].